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Pharm Block 4 > thyroid > Flashcards

thyroid Flashcards

1
Q

associated with hyper metabolic and hyperadrenergic symptoms (tachycardia, palpitations, insomnia, anxiety, tremor, heat intolerance, weight loss)

A

hyperthyroidism

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2
Q

treats hyperthyroidism by inhibiting thyroid peroxidase and 5’ deiodinase - decreasing conversion of T4 into T3

A

propylthiouracil (PTU)

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3
Q

actions of thyroxine

A

growth: bone in children, brain in fetal life and 1st year of postnatal life (lack thyroid hormone in fetal life cretinism)

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4
Q

ADR: severe hepatotoxicity, maculopapular rash, drug induced lupus, agranulocytosis

A

propylthiouracil

can be used in 1st tri

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5
Q

ADR: drug induced lupus, 1st trimester teratogen (b/c of extensive protein binding), cholestatic dysfunction

A

methimazole

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6
Q

used in 2nd and 3rd trimester of pregnancy tp avoid PTU liver toxicity in later trimesters

A

methimazole

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7
Q

uses for PTU and methimazole

A

1) graves
2) radioactive iodine conjunction
3) preoperative preparation of thyroid gland
4) thyrotoxic crisis

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8
Q

associated with dry brittle hair, lethargy, fatigue, weakness, decreased BMR, cold intolerance, myxedema, lack appetite, weight gain

A

Hypothyroidism

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9
Q

untreated hypothyroidism can lead to

A

myxedema coma

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10
Q

treats hypothyroidism and hashimotos

A

levothyroxine (synthetic T4)

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11
Q

ADR: hyperthyroidism, tachycardia, heat intolerance, tremors

A

levothyroxine

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12
Q

used to tx myxedema coma (emergency)

ADR: avoid in heart dz

A

liothyronine sodium

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13
Q

thyroid hormone biologically available in tissue

A

T3

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14
Q

growth: bones in children, brain in fetal life and 1st few years postnatal life (lack of thyroid hormone in fetal life - cretinism) and effects on cardio (increase HR, BF, CO, contraction))

A

actions of thyroxine

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15
Q

thyroid hormone synthesis

A

1) uptake of iodide (trapping)
2) iodide organification : oxidation and iodination
3) coupling of MIT and DIT
4) secretion of thyroid hormones
5) conversion of T4 to T3 (peripheral conversion)

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16
Q 
combo of two DIT 
less potent
75% protein bound
.04% exists in free form
converted to T3 in the peripheral tissues, liver, and kidneys
A

T4

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17
Q 
combo of one MIT and one DIT
4 times more potent 
25% bound
.4% exists in free form
binds actively to nuclear receptor (active form)
A

T3

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18
Q

protrusion of the eyeball
ulceration of cornea
stretches the optic nerve to damage vision

A

exophthalmos

19
Q

TSH decrease
Free T3 increase
Free T4 increase
RAI increase

A

Graves dz

20
Q

TSH decrease
Free T3 increase
Free T4 increase
RAI decrease

A

sub acute thyroiditis

21
Q

TSH decrease
Free T3 increase
Free T4 increase
RAI decrease/normal

A

exogenous T3 or T4

22
Q

TSH increase
Free T3 decrease
Free T4 decrease

A

primary hypothyroidism

23
Q

TSH normal
Free T3 normal
Free T4 normal
RAI normal

A

total T4 increase

pregnancy TBG increase

24
Q

trapped by thyroid gland

radiation destruction of thyroid parenchyma

A

MOA of RAI

25
Q

Uses: graves dz: px with heart dz (after making them euthyroid) and toxic nodular goiter

A

RAI

26
Q

antithyroid drugs should be discontinued 1 week before and resumed 3 days after 131I therapy (decrease efficacy)
iodides should be avoided to prevent competition in uptake

A

Admin of RAI

27
Q

avoid in pregnancy and lactating mothers

can cause hypothyroidism

A

RAI

28
Q

increase delayed hypothyroidism
increase stomach, kidney, breast cancer
increase radiation

A

disadvantages of RAI

29
Q

no risk of surgery

decrease cost

A

advantages of RAI

30
Q

competitively inhibiting the NIS (inhibit uptake of iodine)

large doses can overcome competitive inhibition

A

ionic inhibitors

31
Q

ionic inhibitors

A

thiocyanate
perchlorate
fluoroborate = perchlorate

32
Q

used to tx iodide induced hyperthyroidism like amiodarone induced thyrotoxicosis

A

perchlorate

33
Q

10 times x thiocyanate

aplastic anemia

A

perchlorate

34
Q

inhibits the organification of iodine

A

thiocyanate

35
Q

iodides

A

lugols solution
saturated solution of K iodide (KISS)
K iodide

36
Q

MOA

1) imitation its own transport
2) inhibition of synthesis of iodotyrosine and iodothyronines
3) inhibition of the release of thyroid hormone
4) reduces vascularity and size

A

iodides

37
Q

uses

1) preoperative preparation of thyroid gland
2) thyrotoxic crisi - hyper metabolic state
3) radioactive iodine fallout

A

iodides

38
Q

competes with RAI
not used long term due to escape
vascularity is reduced
gland becomes firmer

A

iodides

39
Q

ADR: marked sensitivity to iodide (allergy), IODISM: chronic intoxication with iodide (brassy taste in mouth), pulmonary edema, in pregnancy: iodide cross placenta and cause fetal goiter

A

iodides

40
Q

adjunct therapy

A

1) beta blockers without ISA - propanolol - use to control hyperthyroidism
2) dexamethasone
3) iopanic acid and sodium ipodate
4) cholestyramine
5) rituximab

41
Q

beta blockers with ISA CI in hyperthyroidism

A 
carteolol
labetalol
penbutolol
pindolol
acebutolol
42
Q

thyrotoxicosis but exaggerated hyperthyroidism

A

thyroid storm

43
Q

tx for thyroid storm

A

1) antithyroid - propylthiouracil
2) B adrenergic blockers - tx HTN and increase HR
3) hydrocortisone - prevnts shock, inhibits peripheral conversion T4 -T3
4) oral iodides - iopanic acid and sodium update
5) tx underlying precipitating illness

Pharm Block 4 (18 decks)

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